Hypertension while lying supine puts patients at higher risk for cardiovascular disease (CVD) events compared with seated hypertension alone, a new cohort study shows. Duc M. Giao, MD, of Harvard Medical School, Boston, and colleagues, reported these results in an article published Wednesday online in JAMA: Cardiology. Hypertension while asleep is known to put individuals at greater risk for CVD and death, but investigators questioned whether this is a risk factor associated with CVD regardless of seated hypertension. Data from the Atherosclerosis Risk in Communities (ARIC) study were used in this prospective cohort study. The ARIC was created in 1987 to look at CVD risk factors in middle-aged adults across four communities in the US. CVD was monitored in over 13,000 middle-aged adults by measuring supine and seated blood pressure (systolic blood pressure ≥130 or diastolic blood pressure ≥80 mm Hg) over 27 years. Patients whose history included coronary heart disease (CHD), stroke or heart failure were excluded from the study. The primary outcomes of this study were incident CHD, heart failure and stroke; fatal CHD and all-cause mortality. The association between supine hypertension with and without seated hypertension was evaluated using Cox proportional hazard models that adjusted for CVD risk factors. A total of 11,369 patients without known CVD were included in this study (55.7% female; 25.1% Black, 74.9% white; mean age=53.9 years). Of those without seated hypertension, 16.4% had supine hypertension. Of those with seated hypertension, 73.5% also had supine hypertension. Patients with supine hypertension had higher rates of incident CHD (hazard ratio [HR]=1.60, 95% confidence interval [CI]=1.45-1.76), heart failure (HR=1.83, 95% CI=1.68-2.01), stroke (HR=1.86, 95% CI=1.63-2.13), fatal CHD (HR=2.18, 95% CI=1.84-2.59) and all-cause mortality (HR=1.43, 95% CI=1.35-1.52) through four median follow-up times. These follow-up times (25th, 75th percentile) included 25.7 years (15.4, 30.4), 26.9 years (17.6, 30.5), 27.6 years (18.5, 30.6 ), 28.3 years (20.5, 30.7) and 28.3 years (20.5, 30.7). No significant differences were found in seated hypertension status nor hypertension medications. Patients who had supine hypertension only had similar risk profiles to patients who had hypertension in both positions, and they had significantly greater risk profiles than patients who had only seated hypertension, aside from fatal CHD. The HRs for seated versus supine patients were 0.72 for CHD, 0.72 for heart failure, 0.66 for stroke and 0.83 for all-cause mortality. Overall, supine hypertension puts patients at greater risk for developing CVD, compared with seated hypertension alone. Source: Giao DM, Col H, Kwapong FL, et al. Supine Blood Pressure and Risk of Cardiovascular Disease and Mortality. JAMA Cardiol. 2025 Jan 22 (Article in Press). Image Credit: MYDAYcontent – stock.adobe.com